ABSTRACT
Introduction: Prone positioning is commonly used when treating ventilated Covid-19 patients. Whilst there have been some reports of ICU proning-related injuries to the brachial plexus well before the pandemic (Goettler et al. 2002), it is usually a very uncommon complication. Despite guidance from the Faculty of Intensive Care Medicine on the care of the proned patient, cases of peripheral neuropathies following ICU admission have significantly increased during the Covid-19 pandemic at our centre (Miller et al. 2021). Nerve injury is associated with reduced quality of life, impaired activity participation and persistent pain (Bailey et al. 2009). Objectives: The aim of this quality improvement project was to identify the effect that new guideline development and related healthcare professional education had on the number and severity of peripheral neuropathies identified following Covid-19 ICU admission. Methods: Between March 2020 and May 2021, we collected clinical data from patients who sustained peripheral neuropathies during their inpatient stay for Covid-19. Data were collected via face-to-face patient assessments within acute nerve clinics or post-ICU rehabilitation wards. A grading system was used to categorise the peripheral nerve injuries into severe, intermediate and mild (Power et al. 2020). Electronic ICU clinical noting was examined to identify the frequency and duration of each proning episode for each patient who presented with nerve injury. Following the first surge in 2020 updated proning guidelines were developed with ICU team leaders and disseminated. This involved face-to-face education of frontline staff. Results: At our centre 93 patients survived Covid ICU between March -June 2020 (surge 1) and 21 of those sustained nerve injury (22.58%). 309 patients survived Covid ICU between September 2020 -May 2021 (surge 2) and 12 of those sustained nerve injury (3.88%). For patients who sustained nerve injury, the average number of prones changed between surges from 6 to 13. The average duration of each episode of proning changed from 17.8hrs to 18.6hrs. Despite the increase in prone frequency, nerve injury occurrence reduced (proportionate to the number of patients who survived Covid ICU) by 82%. 14/21 (66%) injuries acquired in the first surge were of high grade and 4/ 12 (33%) were of high grade during the second surge. Conclusion: Optimising positioning of the proned ventilated patient may reduce the incidence of nerve injury. However, we must also acknowledge that changes in medical management between surges (i.e. use of dexamethasone, remdesivir) may have contributed to this. Individuals still developed severe injury despite this change in practice. Further research looking into risk factors and further methods of optimising the prone positioning on ICU is warranted to reduce the occurrence of this potentially life-changing injury.
ABSTRACT
The 2021 edition of Rural America at a Glance focuses on aspects affecting the resiliency and recovery of rural communities in the wake of the COVID-19 pandemic, including population and employment change, intensity of infection and vaccination rates, and internet availability and adoption.
ABSTRACT
Housing is central to older adults' life outcomes. Housing's affordability, physical quality, and location can impact physical and mental health. Housing policies and practices have systematically limited access to homeownership for persons of color and segregated many into disadvantaged neighborhoods. For many, this has curtailed economic and wealth building opportunities over the life course and exposed them to negative health consequences of segregated neighborhoods. Encouraging and supporting equitable access to safe and quality housing options for older adults should be a role for all aging services stakeholders.
ABSTRACT
Housing is central to older adults' life outcomes. Housing's affordability, physical quality, and location can impact physical and mental health. Housing policies and practices have systematically limited access to homeownership for persons of color and segregated many into disadvantaged neighborhoods. For many, this has curtailed economic and wealth building opportunities over the life course and exposed them to negative health consequences of segregated neighborhoods. Encouraging and supporting equitable access to safe and quality housing options for older adults should be a role for all aging services stakeholders. © 2020 American Society on Aging;all rights reserved. This article may not be duplicated, reprinted or distributed in any form without written permission from the publisher: American Society on Aging, 575 Market St.,Suite 2100, San Francisco, CA 94105-2869;e-mail: info@asaging.org. For information about ASAs publications visit www.asaging.org/publications. For information about ASA membership visit www.asaging.org/jOin.
ABSTRACT
Study Objective An isthmocele is a cesarean scar site defect with a depth of >2mm and can lead to both obstetric and gynecologic complications. The primary objective was to evaluate the feasibility of a study protocol comparing different cesarean section closure techniques amongst our own patients/physicians, with the ultimate goal of a larger scale randomized controlled trial (RCT). Secondary objectives included isthmocele incidence, measurements on postoperative ultrasound, and adverse surgical outcomes related to suture technique. Design A single-center parallel-group pilot RCT comparing locked vs. unlocked first-layer uterine closure. Outpatient transvaginal ultrasound to evaluate isthmocele formation was performed at least six months postoperatively. Setting Operating room and outpatient ultrasound clinic. Patients or Participants All term pregnant patients >18 years old undergoing a primary caesarean section were eligible. Exclusion criteria included previous uterine hysterotomy, known uterine anomalies, active labour, and maternal bleeding and/or connective tissue disorders. Interventions Locked or unlocked closure of the first uterine layer. Measurements and Main Results Forty-one subjects were randomized, and 23 completed the follow-up ultrasound, with 12 in the locked group and 11 in the unlocked group. Barriers to feasibility included hesitance to participate in research during pregnancy, difficulty attending follow-up ultrasound with a newborn, and mainly Covid-19 pandemic related delays in study activities and fear of potential exposures. Isthmocele was present in 10/12 patients receiving locked closure, and in 11/11 of the unlocked group. Mean sagittal depth was 0.36 cm and 0.40 cm in the locked vs. unlocked groups, respectively. Sagittal adjacent myometrial thickness was 1.03 cm in the locked group, and 1.12 cm in the unlocked group. No adverse outcomes were noted with either surgical technique. Conclusion The study design is feasible outside of the pandemic setting. A larger trial is needed to determine differences regarding isthmocele rates and measurements between groups.
ABSTRACT
In this exploratory study, we scrutinize a database of over one million tweets collected from March to July 2020 to illustrate public attitudes towards mask usage during the COVID-19 pandemic. We employ natural language processing, clustering and sentiment analysis techniques to organize tweets relating to mask-wearing into high-level themes, then relay narratives for each theme using automatic text summarization. In recent months, a body of literature has highlighted the robustness of trends in online activity as proxies for the sociological impact of COVID-19. We find that topic clustering based on mask-related Twitter data offers revealing insights into societal perceptions of COVID- 19 and techniques for its prevention. We observe that the volume and polarity of mask-related tweets has greatly increased. Importantly, the analysis pipeline presented may be leveraged by the health community for qualitative assessment of public response to health intervention techniques in real time.